Walk down a drugstore aisle and you'd think Americans' teeth were about to fall out.
In the past two years alone, manufacturers have launched 130 or so varieties of toothpaste that boast tartar-control properties, baking soda, peroxide and whitening ingredients. There are pastes and gels in fact, you have to pick between gels -- regular or sparkling neon-bright for kids.
The latest addition is Colgate's Total, featuring the antibiotic triclosan and winning the U.S. Food and Drug Administration's first approval to be marketed as helping to prevent gum disease.
Plenty more teeth-cleaning concoctions are in the works and, ironically, at a time when Americans' teeth generally are healthier than ever.
The number of school-age children without cavities in their permanent teeth, for example, has doubled in the past two decades, according to the American Dental Association. Older adults also are keeping more of their teeth; toothlessness among working adults ages 55 to 64 has declined from 30 percent in the early 1970s to 15 percent in the mid-1980s.
But healthy chops aren't enough for most of us. Vanity has us on a Holy Grail-like quest for a perfect smile. We're willing to shell out anywhere from a few bucks for an over-the-counter product to hundreds for an outpatient procedure.
Americans spend about $1.5 billion annually on toothpaste, and about $250 million a year to bleach, cap or otherwise whiten their teeth, according to the Den-Mat Corp., which markets the Rembrandt line of toothpastes and mouthwashes. The whitening industry has become one of the biggest and most profitable segments of oral care.
Toothpaste makers are busy brewing newer formulas, for no small investment. Colgate committed $35 million, 10 years and a team of 200 employees to develop its new Total toothpaste. The ADA receives hundreds of requests annually from toothpaste manufacturers looking for the agency's stamp of approval, says Ken Burrell, senior director of ADA's council on scientific affairs.
So many choices
For consumers, sorting through the avalanche of choices can be overwhelming. Whatever you choose, dentistry experts say, always read a package's fine print. Manufacturers can't lie about what their products can achieve because the ADA will scrutinize those claims before handing out any seal of approval.
A tube of whitening toothpaste, for example, will advertise its ability to prevent and reduce stains, resulting in whiter teeth. That's a legitimate claim. Most contain abrasive ingredients to scrub off stains on the tooth's outer layer; a few include bleaching agents.
But a whitening toothpaste never will promise results so white that a supermodel would be jealous. Only a dentist can safely penetrate a tooth's exterior and bleach the underlying surface to give you a dramatically whiter smile.
"I haven't found a whitening toothpaste that works at all," says Dr. Myron Kellner of Lutherville and Baltimore, master dentist of the American Academy of General Dentistry.
He adds, "Don't use a toothpaste that's too abrasive," such as ones that claim to remove smoking stains.
Dealing with tartar
Tartar-control formulas, introduced in the mid-1980s, help prevent the formation of soft plaque that can turn into hard tartar, which leads to gum disease and rotting teeth.
They are "minimally effective," says Kellner. But the only really effective way of dealing with tartar is by "physically removing it by having one's teeth cleaned periodically by a dental hygienist."
And Diane Melrose, interim chair of the dental hygiene department at the University of Southern California School of Dentistry, warns that anti-tartar formulas can help reduce buildup on exposed teeth, but not portions of your teeth covered by gums.
The next generation of toothpastes arrived in the late '80s and early '90s: adding baking soda, then peroxide.
"A lot of people like the crunch quality that baking soda can give," the ADA's Burrell said, "and some people like the bubbly feel that peroxide can give" since it oxygenates. But they only clean teeth and freshen breath -- "they're not adding any benefit to your oral health."
Dr. Pat Higgins of Denton, former president of the Eastern Shore Dental Association, says that "generally, baking soda and peroxide are very helpful in fighting the battle against bacteria in the mouth," but she's found that some people dislike the bad taste or dryness of mouth that can result.
Colgate's new Total plays into consumer anxieties about germs and disease.
The toothpaste includes triclosan, an anti-bacterial agent that has been around for years in soaps and deodorants. Although the agent prevents plaque and tartar buildup, triclosan alone isn't stable and dissolves in the mouth after brushing.
The future probably will bring even fancier combinations, but there's no need to despair. There's a simple solution to the toothpaste dilemma.